Multi-Sensor-Fusion Approach for a Data-Science-Oriented Preventive Health Management System: Concept and Development of a Decentralized Data Collection Approach for Heterogeneous Data Sources.

Investigations in preventive and occupational medicine are often based on the acquisition of data in the customer's daily routine. This requires convenient measurement solutions including physiological, psychological, physical, and sometimes emotional parameters. In this paper, the introduction of a decentralized multi-sensor-fusion approach for a preventive health-management system is described. The aim is the provision of a flexible mobile data-collection platform, which can be used in many different health-care related applications. Different heterogeneous data sources can be integrated and measured data are prepared and transferred to a superordinated data-science-oriented cloud-solution. The presented novel approach focuses on the integration and fusion of different mobile data sources on a mobile data collection system (mDCS). This includes directly coupled wireless sensor devices, indirectly coupled devices offering the datasets via vendor-specific cloud solutions (as e.g., Fitbit, San Francisco, USA and Nokia, Espoo, Finland) and questionnaires to acquire subjective and objective parameters. The mDCS functions as a user-specific interface adapter and data concentrator decentralized from a data-science-oriented processing cloud. A low-level data fusion in the mDCS includes the synchronization of the data sources, the individual selection of required data sets and the execution of pre-processing procedures. Thus, the mDCS increases the availability of the processing cloud and in consequence also of the higher level data-fusion procedures. The developed system can be easily adapted to changing health-care applications by using different sensor combinations. The complex processing for data analysis can be supported and intervention measures can be provided.

Cardiovascular recovery after workload in German shift workers in the hotel and catering industry: results of 24-hour-ambulatory monitoring of heart rate and blood pressure.

PURPOSE: Shift work is associated with an impairment of sleep-wake cycles that can affect cardiovascular recovery (CR) negatively. The aim of this study was to examine CR of shift and day workers in the hotel and catering industry (HCI) and identify predictors of CR. METHODS: The sample consisted of 64 alternating and 96 day workers in the HCI. Monitoring of blood pressure (BP) and heart rate (HR) was conducted for 24 hours per working day during work, leisure and sleep. The CR process was examined for differences between work and leisure, work and sleep regarding a reduction in BP and HR. Lifestyle (physical activity, smoking, drinking) was assessed through questionnaires, BP over a four-day, self-assessment period (38% hypertensives). Participants taking BP medication (n = 12) were excluded from analyses. RESULTS: Shift workers had significantly higher BP (Ø 146/87 vs. Ø 140/84 mmHg; p = 0.034-0.044) and HR (Ø 86 vs. 82 bpm; p = 0.032) during their work phase verses day workers. There were no differences found for the CR between work and leisure nor work and sleep. As predictors of the CR, classic cardiovascular indicators (blood pressure status, smoking, age, physical activity, sex) were found which explains between 14% (HR) and 30% (BP) of the variance. Shift work was not a predictor for CR. CONCLUSIONS: Employees in the HCI show that their CR is mainly determined by the known cardiovascular indicators and less by shift work. This effect needs to be discussed in relation to the job requirements and the cardiovascular health of the employees.

A Low-Cost, Standalone, and Multi-Tasking Watch for Personalized Environmental Monitoring.

A novel hardware approach with four physical layers and several integrated and add-on sensors for a comprehensive physical and chemical environmental parameter (toxic gases, sound level, air pressure, humidity, temperature, and motion tracking) monitoring is introduced in this paper. To provide flexibility, the system is modular and each sensor functions independently. The whole solution is small, compact, light, and wrist worn. It is working in low power consumption mode and operates for several hours. The device has two layers to implement the sensors and one layer for a warning system driver to enable the vibrating motor and beeper in emergency status. The forth layer is the hardware flex interface that is connected to the display and sound module and provides the possibility of the hardware extension for further development. The gas sensor node includes the sensor attached to the driver (located at the top) and is replaceable with other target gas sensors from the same family. The warning system is located at the bottom of the proposed device. The sampled data from the sensors are monitored in real time via the display and are sent to an Android smartphone for permanent storage via Bluetooth Low Energy(BLE) 4.1. Consequently, these data will be directed to a cloud for further medical analyses. Power consumption, results, device efficiency, and packet protocol justification are evaluated in this paper.

Early Detection of Undiagnosed Hypertension Based on Occupational Screening in the Hotel and Restaurant Industry.

Blood pressure is the most important, modifiable risk factor for cardiovascular diseases. Lifestyle factors and also workload are the main, potential risk factors for the development of hypertension. This study focused on the early detection of unknown hypertension by screening employees in the hotel and restaurant industry (HRI). 148 HRI employees without hypertension (mean age: 34 years, men: 45%) self-measured their blood pressure during rest and for 24 hours of a normal workday. Individuals with a resting blood pressure ≥ 135/85 mmHg were classified as hypertensive. A further analysis investigated whether the currently applicable thresholds for hypertension during work, leisure, and sleep were exceeded on a working day. At rest, 36% of the study participants suffered from hypertension, which increased to 70% under workload and 46% during leisure time and dropped to 8% during sleep. Normal nocturnal dipping (10-20%) occurred only in 18% of cases; 78% were extreme dippers (>20%). Occupational hypertension screening is a suitable component of preventive healthcare. Resting blood pressure measurement alone is insufficient for the early detection of risk individuals and should be supplemented by 24-hour ambulatory blood pressure monitoring under working conditions. The impact of workload on blood pressure needs to be given more attention in the guidelines.

Wearable Devices in Medical Internet of Things: Scientific Research and Commercially Available Devices.

OBJECTIVES: Wearable devices are currently at the heart of just about every discussion related to the Internet of Things. The requirement for self-health monitoring and preventive medicine is increasing due to the projected dramatic increase in the number of elderly people until 2020. Developed technologies are truly able to reduce the overall costs for prevention and monitoring. This is possible by constantly monitoring health indicators in various areas, and in particular, wearable devices are considered to carry this task out. These wearable devices and mobile apps now have been integrated with telemedicine and telehealth efficiently, to structure the medical Internet of Things. This paper reviews wearable health care devices both in scientific papers and commercial efforts. METHODS: MIoT is demonstrated through a defined architecture design, including hardware and software dealing with wearable devices, sensors, smart phones, medical application, and medical station analyzers for further diagnosis and data storage. RESULTS: Wearables, with the help of improved technology have been developed greatly and are considered reliable tools for long-term health monitoring systems. These are applied in the observation of a large variety of health monitoring indicators in the environment, vital signs, and fitness. CONCLUSIONS: Wearable devices are now used for a wide range of healthcare observation. One of the most important elements essential in data collection is the sensor. During recent years with improvement in semiconductor technology, sensors have made investigation of a full range of parameters closer to realization.

German version of the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ): translation and validation.

BACKGROUND: Musculoskeletal disorders are a public health problem with significant effects on work ability. In the context of the promotion and prevention of work-related health, there is a need for valid, simple, time-saving and universally applicable methods for the assessment of musculoskeletal pain and complaints. The aim of this study was the translation of the English Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) into German and the validation of the German version. METHODS: The linguistic and cultural adaption of the CMDQ into German (D-CMDQ) followed international guidelines. The adapted pre-version was initially tested in terms of comprehensibility on 44 persons with different educational and occupational backgrounds. The questionnaire was validated further on 68 employees with the reference of an 11-point Numeric Rating Scale (Cohen's Kappa and Spearman's rank correlation coefficients). Finally, reliability (Cohen's Kappa) and internal consistency (Cronbach's alpha) were verified. RESULTS: The D-CMDQ meets the requirements for comprehensibility and demonstrated good validity: The values of Cohen's Kappa and Spearman's rank correlation coefficient obtained substantial to excellent agreement, with one exception. The Kappa values for the test-retest reliability were mainly in the moderate to substantial range whilst taking the prevalence effect into account. The internal consistency was proven satisfactory. CONCLUSIONS: The D-CMDQ meets the psychometric requirements for questionnaires. A clear one-sided presentation of body areas enables the time-saving assessment of musculoskeletal complaints and their effects on work ability. As a result, a broad application in the German-speaking world for different occupational groups seems possible, whether performing physical, manually repetitive or sedentary work.

A Stochastic Framework for Robust Fuzzy Filtering and Analysis of Signals-Part I.

There are numerous applications across all the spectrum of scientific areas that demand the mathematical study of signals/data. The two typical study areas of theoretical research on signal/data processing are of modeling (i.e., understanding of signal's behavior) and of analysis (i.e., evaluation of given signal for finding its association to existing signal models). The objective of this paper is to provide a stochastic framework to design both fuzzy filtering and analysis algorithms in a unified manner. The signals are modeled via linear-in-parameters models (e.g., a type of Takagi-Sugeno fuzzy model) based on variational Bayes (VB) methodology. This gives rise to the "negative free energy maximizing" filtering algorithm. The issue of intractability was handled first by carefully choosing the priors as conjugate to the likelihood and then by using Stirling approximation for the Gamma function. This paper highlighted that it was analytically possible to maximize the information theoretic quantity, "mutual information," exactly in the same manner as maximizing "negative free energy" in VB methodology. This gives rise to the "variational information maximizing" analysis algorithm. The robustness of the methodology against data outliers is achieved by modeling the noises with Student- t distributions. The framework takes into account the inputs noises as well apart from the usually considered output noise. The robustness of the adaptive filtering algorithm against noise is shown by a deterministic analysis where an upper bound on the magnitude of estimation errors is derived.

Promoting Best Practices for Managing Acute Low Back Pain in an Occupational Environment.

Providers treating low back pain must be confident and knowledgeable in evidence-based practice (EBP) to provide the best outcomes. An online education course was created in an effort to increase knowledge and confidence in EBP and clinical practice guidelines specific to low back pain in an occupational setting. There were 80 participants who completed the pre-test and post-test. The results showed a statistically significant improvement in knowledge and confidence scores after completion of the course. An online education course was shown to be a cost-effective, accessible tool to increase knowledge and confidence of EBP for different health care providers.

Evaluation of the physical activity of German soldiers depending on rank, term of enlistment, and task area.

Physical fitness of soldiers plays an important role during combat operations and training for deployment. The aim of this study was to collect data on the physical activity of soldiers of all rank categories and to identify task areas in which inactivity and the resulting health problems such as obesity, cardiovascular disease, and musculoskeletal problems pose a special risk. For this purpose, the physical activity of 169 German soldiers of different ranks and task areas was measured. These soldiers wore accelerometer-based physical activity monitors for a period of 7 days. Their activities were also documented in standardized forms. The results showed that officers (541 steps/h) had the lowest level of physical activity during their duties (compared to noncommissioned officers): 600 steps/h, and junior enlisted personnel: 724 steps/h). With respect to term of enlistment, conscripts and temporary-career volunteers showed a higher level of physical activity than regulars (751 and 640 vs. 539 steps/h). With respect to different task areas, drivers showed the highest activity level, whereas staff personnel showed the lowest. High-ranking personnel and soldiers in staff positions were shown to have the lowest physical activity level. In these groups, possible health problems caused by physical inactivity could be alleviated.

Psychophysical workload in the operating room: primary surgeon versus assistant.

BACKGROUND: Working in the operating room is characterized by high demands and overall workload of the surgical team. Surgeons often report that they feel more stressed when operating as a primary surgeon than in the function as an assistant which has been confirmed in recent studies. In this study, intra-individual workload was assessed in both intraoperative functions using a multidimensional approach that combined objective and subjective measures in a realistic work setting. METHODS: Surgeons' intraoperative psychophysiologic workload was assessed through a mobile health system. 25 surgeons agreed to take part in the 24-hour monitoring by giving their written informed consent. The mobile health system contained a sensor electronic module integrated in a chest belt and measuring physiological parameters such as heart rate (HR), breathing rate (BR), and skin temperature. Subjective workload was assessed pre- and postoperatively using an electronic version of the NASA-TLX on a smartphone. The smartphone served as a communication unit and transferred objective and subjective measures to a communication server where data were stored and analyzed. RESULTS: Working as a primary surgeon did not result in higher workload. Neither NASA-TLX ratings nor physiological workload indicators were related to intraoperative function. In contrast, length of surgeries had a significant impact on intraoperative physical demands (p < 0.05; η(2) = 0.283), temporal demands (p < 0.05; η(2) = 0.260), effort (p < 0.05; η(2) = 0.287), and NASA-TLX sum score (p < 0.01; η(2) = 0.287). CONCLUSIONS: Intra-individual workload differences do not relate to intraoperative role of surgeons when length of surgery is considered as covariate. An intelligent operating management that considers the length of surgeries by implementing short breaks could contribute to the optimization of intraoperative workload and the preservation of surgeons' health, respectively. The value of mobile health systems for continuous psychophysiologic workload assessment was shown.

A stochastic framework for robust fuzzy filtering and analysis of signals--part II.

This text provides several applications scenarios of introduced signals' modeling and analysis framework to solve the practical problems. Some of the challenging practical problems related to signal/data processing have been formulated in a manner that the negative free energy maximizing filtering and variational information maximizing analysis algorithms of Kumar et al. could be directly applied to solve the problems. The studied application examples include robust comparison of objects' geometries in images for child ear biometrics, biomedical signals classification, data smoothing for reflection-mode ultrasound imaging, and modeling related applications. The application examples support the mathematical theory of Kumar et al. by providing just the proof-of-concept.

Heart rate and heart rate variability as indirect markers of surgeons' intraoperative stress.

OBJECTIVE: In a difficult and demanding environment such as the operating room, the individual workload response of physicians is of particular importance. The aim of this study was to examine the specific effects of intraoperative stress on the cardiovascular system by measuring heart rate (HR) and heart rate variability (HRV). METHODS: In a cross-sectional study, the effect of intraoperative stress on autonomic balance, measured by HRV, among surgeons differing with respect to their intraoperative stress levels was studied. Based on their perceived stress (State Trait Anxiety Inventory), surgeons were classified into a stressed and a non-stressed sample. Data on HR and HRV were collected by means of ambulatory ECG-recordings. Changes in autonomic nervous system activity were quantified by frequency and time domain analysis of R-R interval variability. Demographic, anthropometric, and surgery-related group differences were assessed by non-parametric Mann-Whitney U test, differences between relative changes of HR and HRV by Wilcoxon signed-ranks test. In multivariate linear analysis of covariance, group differences were adjusted for possible confounding factors. RESULTS: There was a significant difference in intraoperative HR for stressed and non-stressed surgeons (median: 99.3 vs. 63.7; P < 0.05). During sleep, HRV indices indicated a reduced autonomic recovery in stressed participants. CONCLUSIONS: Our results reveal that higher perceived stress in the operating room is associated with increased intraoperative HR and decreased HRV at night. Non-stressed surgeons show greater relaxation during sleep compared to their stressed colleagues.

Heart rate variability and blood pressure during dynamic and static exercise at similar heart rate levels.

UNLABELLED: Aim was to elucidate autonomic responses to dynamic and static (isometric) exercise of the lower limbs eliciting the same moderate heart rate (HR) response. METHOD: 23 males performed two kinds of voluntary exercise in a supine position at similar heart rates: static exercise (SE) of the lower limbs (static leg press) and dynamic exercise (DE) of the lower limbs (cycling). Subjective effort, systolic (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), rate pressure product (RPP) and the time between consecutive heart beats (RR-intervals) were measured. Time-domain (SDNN, RMSSD), frequency-domain (power in the low and high frequency band (LFP, HFP)) and geometric measures (SD1, SD2) as well as non-linear measures of regularity (approximate entropy (ApEn), sample entropy (SampEn) and correlation dimension D2) were calculated. RESULTS: Although HR was similar during both exercise conditions (88±10 bpm), subjective effort, SBP, DBP, MAP and RPP were significantly enhanced during SE. HRV indicators representing overall variability (SDNN, SD 2) and vagal modulated variability (RMSSD, HFP, SD 1) were increased. LFP, thought to be modulated by both autonomic branches, tended to be higher during SE. ApEn and SampEn were decreased whereas D2 was enhanced during SE. It can be concluded that autonomic control processes during SE and DE were qualitatively different despite similar heart rate levels. The differences were reflected by blood pressure and HRV indices. HRV-measures indicated a stronger vagal cardiac activity during SE, while blood pressure response indicated a stronger sympathetic efferent activity to the vessels. The elevated vagal cardiac activity during SE might be a response mechanism, compensating a possible co-activation of sympathetic cardiac efferents, as HR and LF/HF was similar and LFP tended to be higher. However, this conclusion must be drawn cautiously as there is no HRV-marker reflecting "pure" sympathetic cardiac activity.

Tri-axial high-resolution acceleration for oxygen uptake estimation: Validation of a multi-sensor device and a novel analysis method.

We validated a multi-sensor chest-strap against indirect calorimetry and further introduced the total-acceleration-variability (TAV) method for analyzing high-resolution accelerometer data. Linear regression models were developed to predict oxygen uptake from the TAV-processed multi-sensor data. Individual correlations between observed and TAV-predicted oxygen uptake (V̇O2) were strong (mean r = 0.94) and bias low (1.5 mL·min(-1)·kg(-1), p < 0.01; 95% confidence interval: 8.7 mL·min(-1)·kg(-1); -5.8 mL·min(-1)·kg(-1)); however, caution should be taken when a single-model value is used as a surrogate for V̇O2.

Health effects and acceptance of a physical activity program for older long-term unemployed workers.

PURPOSE: Long-term unemployment has negative effects on both mental and physical health. In combination with an inactive lifestyle, it often leads to functional or constitutional limitations that make reemployment in the labor market difficult especially for older adults. The presented pilot study examined a 3-month-long interventional program for improving health of older, long-term unemployed persons with regard to its effectiveness and acceptance by the target group. METHODS: The low-threshold intervention was offered by a job training center that supports reemployment and was divided into lectures for enhancing the individual health competence and a supervised physical training part in a fitness center. One hundred and nineteen long-term unemployed workers (53.7 ± 3 years) took part in a prospective investigation with 3 data collection points: before intervention (T1), after intervention (T2, n = 94), and 6 month after intervention (T3, n = 59). The spectrum of methods included the assessment of nutritional status, cardiovascular risk factors, physical fitness, chronic backache, and depression. RESULTS: As a result of the intervention, the physical fitness improved significantly (maximal oxygen uptake: p < 0.002). Cardiovascular risk factors like systolic and diastolic blood pressure (p < 0.016; p < 0.001) and percentage body fat (p < 0.017) decreased significantly. There were also remarkable effects in the reduction in depression (p < 0.028). Chronic backache was lowered in more than 50% of the cases. CONCLUSION: The health promotion program reached people who have a desire to improve both physical and mental health. To assume responsibility for their own health may be a first step in regaining self-confidence and lowering the work placement barriers.

Stress and fitness monitoring embedded on a modern telematics platform.

Lack of regular physical activity and high stress levels are the leading causes of several illnesses. There is thus a real need for a personal low-cost and mobile monitoring solution over extended periods to prevent health risks. Based on the above fact, this article presents a system capable of estimating and monitoring both stress and fitness levels without a physical consultation of a medical specialist. The system consists of three main subcomponents: a mobile real-time acquisition of physiological as well as subjective data, an expert model for stress and fitness estimations based on physiological signals collected from wireless vital sensors, and a secure and scalable telematics platform on which the entire system is embedded. Features and tasks performed by the telematics platform will be presented. The experimental part of the work involved a representative number of subjects. Results for 110 subjects whose fitness levels were assessed at different periods of the year and 50 individuals whose stress scores were assessed at different times of the day showed a high correlation of the estimated values with the true ones. The application of such a low-cost monitoring system will improve the quality of service in preventive medicine.

Maltose and maltodextrin utilization by Listeria monocytogenes depend on an inducible ABC transporter which is repressed by glucose.

BACKGROUND: In the environment as well as in the vertebrate intestine, Listeriae have access to complex carbohydrates like maltodextrins. Bacterial exploitation of such compounds requires specific uptake and utilization systems. METHODOLOGY/PRINCIPAL FINDINGS: We could show that Listeria monocytogenes and other Listeria species contain genes/gene products with high homology to the maltodextrin ABC transporter and utilization system of B. subtilis. Mutant construction and growth tests revealed that the L. monocytogenes gene cluster was required for the efficient utilization of maltodextrins as well as maltose. The gene for the ATP binding protein of the transporter was located distant from the cluster. Transcription analyses demonstrated that the system was induced by maltose/maltodextrins and repressed by glucose. Its induction was dependent on a LacI type transcriptional regulator. Repression by glucose was independent of the catabolite control protein CcpA, but was relieved in a mutant defective for Hpr kinase/phosphorylase. CONCLUSIONS/SIGNIFICANCE: The data obtained show that in L. monocytogenes the uptake of maltodextrin and, in contrast to B. subtilis, also maltose is exclusively mediated by an ABC transporter. Furthermore, the results suggest that glucose repression of the uptake system possibly is by inducer exclusion, a mechanism not described so far in this organism.

Mobile real-time data acquisition system for application in preventive medicine.

In this article, the development of a system for online monitoring of a subject's physiological parameters and subjective workload regardless of location has been presented, which allows for studies on occupational health. In the sector of occupational health, modern acquisition systems are needed. Such systems can be used by the subject during usual daily routines without being influenced by the presence of an examiner. Moreover, the system's influence on the subject should be reduced to a minimum to receive reliable data from the examination. The acquisition system is based on a mobile handheld (or smart phone), which allows both management of the communication process and input of several dialog data (e.g., questionnaires). A sensor electronics module permits the acquisition of different physiological parameters and their online transmission to the handheld via Bluetooth. The mobile handheld and the sensor electronics module constitute a wireless personal area network. The handheld allows the first analysis, the synchronization of the data, and the continuous data transfer to a communication server by the integrated mobile radio standards of the handheld. The communication server stores the incoming data of several subjects in an application-dependent database and allows access from all over the world via a Web-based management system. The developed system permits one examiner to monitor the physiological parameters and the subjective workload of several subjects in different locations at the same time. Thereby the subjects can move almost freely in any area covered by the mobile network. The mobile handheld allows the popping-up of the questionnaires at flexible time intervals. This electronic input of the dialog data, in comparison to the manual documentation on papers, is more comfortable to the subject as well as to the examiner for an analysis. A Web-based management application facilitates a continuous remote monitoring of the physiological and the subjective data of the subject.